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PubMed1998

Pilot study of a semi-flexible intra-oral appliance for the control of snoring.

OBJECTIVE: To determine the effectiveness and acceptability of an intra-oral appliance in the reduction of snoring, with construction and fitting as a 1-visit process. DESIGN AND SETTING: This was a prospective study. Patients were attending a hospital sleep breathing disorders clinic and appliances were made at a dental hospital. This work was carried out in the UK during 1996 and 1997. SUBJECTS AND METHODS: Patients were selected from those referred to a sleep breathing disorders clinic with socially disruptive snoring. MAIN OUTCOME MEASURES: Patients were assessed by means of limited sleep studies and by questionnaires before and after fitting of the appliances. The sleep studies consisted of monitoring respiratory variables (principally oronasal airflow and nocturnal oxygen saturation). A respiratory disturbance index was assigned. Questionnaires were completed by both patients and sleep partners, with many of the responses being marked on visual analogue scales. RESULTS: 16 male patients, mean age 49 years, were included in the trial. 14 were able to wear the appliance and their level of snoring, as assessed by their sleep partners, reduced from a mean of 8.8 out of 10 to 4.2 out of 10 (P = 0.0003, paired t-test). CONCLUSION: It is concluded that the semi-flexible intra-oral appliance is effective in the control of snoring.

Adult↗
PubMed1994

Ambulatory blood pressure and left ventricular hypertrophy in subjects with untreated obstructive sleep apnoea and snoring, compared with matched control subjects, and their response to treatment.

1. Obstructive sleep apnoea and snoring are associated with daytime hypertension. It is uncertain whether this association is directly due to the disturbed sleeping respiration or the result of confounding variables, particularly obesity, smoking and alcohol intake. 2. Ambulatory blood pressure and echocardiographic left ventricular muscle mass were measured in 19 patients with obstructive sleep apnoea, 19 men who snore without apnoea and 38 control subjects matched for age, sex, body mass index, smoking and alcohol intake. Ambulatory blood pressure was also measured before and after treatment in 11 patients with obstructive sleep apnoea and their matched control subjects. 3. Compared with matched control subjects, untreated obstructive sleep apnoea and snoring were not associated with an increase in daytime blood pressure. A daytime elevation of either systolic or diastolic blood pressure of > 3.8 mmHg due to obstructive sleep apnoea or snoring was excluded with 95% confidence in each of the study groups. Daytime blood pressure was also unchanged when obstructive sleep apnoea was treated with nasal continuous positive airway pressure. Night-time blood pressure was not significantly different in the patients with obstructive sleep apnoea or the snorers when compared with their matched control subjects. However, a fall in night-time systolic blood pressure was seen in the patients with obstructive sleep apnoea after treatment [fall in systolic blood pressure -6.3 (SD 8.2) mmHg, P < 0.02]. 4. Left ventricular diameter, wall thickness and calculated mass were similar in each of the study groups and their matched control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure Determination↗
PubMed2003

Snoring, daytime sleepiness and stroke: a case-control study of first-ever stroke.

Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA). We performed a case-control study of 181 patients admitted to hospital with first-ever stroke and community control subjects matched individually for age, sex and general practitioner. Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41). Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke. The results suggest that the previously reported association between 'simple' snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness prestroke, the cause of which is unclear, although OSA is a possible candidate.

Adult↗
PubMed1996

Snoring--a simple surgical solution.

In this paper a new palatal surgical technique for the treatment of snoring is described and evaluated. All 22 patients were severe snorers with no significant obstructive sleep apnoea, as confirmed by detailed sleep studies. The aim of the surgical technique was to eliminate the vibration of the soft palate and the posterior pillars which occurs during snoring. This was achieved under general anaesthetic by making a 1.5 cm vertical full thickness incision in the soft palate from the superior pole of the tonsil towards the pterygoid hamulus using monopolar cutting diathermy. Specifically designed daily pain questionnaires were completed by the patients during the first 2 post-operative weeks and the level of snoring was assessed by the patient's sleeping partner at 2, 6 and 12 weeks. The presence of any complications was also documented at these times. The results demonstrate that this surgical technique is effective, quick, simple and bloodless. The post-operative pain created is mild and quickly resolves. All patients experienced a dramatic diminution of their snoring and in 55% complete cessation was achieved.

Anesthesia, General↗
PubMed2003

Somnoplasty for simple snoring--a pilot study.

A prospective pilot study was conducted to investigate the efficacy of radiofrequency thermal ablation (RFTA) of the soft palate to treat simple snoring. Ten consecutive, consenting patients were recruited following history, examination, Epworth scoring, sleep nasendoscopy and full polysomnography. All the patients received two treatments of three lesional RFTA of the soft palate under local anaesthesia, using the Somnus S2 generator. Each treatment was separated by 6 weeks. Patients completed a questionnaire which used visual analogue scales to score pain during the procedure as well as the postoperative period. Snoring was also scored on visual analogue scales by both the patient and the partner. Objective assessment was based on full polysomnography 3 months after the second treatment. Sixty per cent of patients subjectively reported improvement in snoring. Objectively, only 30% showed improvement in duration of snoring (38-48% better) with no change in intensity. There was high patient acceptability of the procedure.

Adult↗
PubMed1997

Ventilatory response to CO2 in patients with snoring, obstructive hypopnoea and obstructive apnoea.

Obstructive sleep apnoea (OSA) is caused by an obstruction of the upper airway. Sufficient sensitivity to CO2 in the respiratory centre is known to be a critical factor for adequate tone in the upper airway muscles. The hypothesis of this study is, therefore, that the ventilatory response to CO2 is reduced in patients with OSA. Twenty-six patients who suffered from snoring, 19 snoring patients with obstructive hypopnoea (OH) and 33 snoring patients with obstructive apnoea (OA), were studied. The control group consisted of 25 subjects from a random sample with no history of snoring or daytime sleepiness. Tests of the hyperoxic and hypoxic ventilatory response to CO2 were performed, as well as static and dynamic spirometry. Subjects in the OA group displayed a higher hyperoxic (VE/FetCO2hy = 12.6 l min-1/%) and hypoxic (VE/FetCO2ho = 15.7 l min-1/%) ventilatory response to CO2 than patients with obstructive hypopnoea (VE/FetCO2hy = 8.6 l min-1/%; VE/FetCO2ho = 15.2 l min-1/%), snorers (VE/FetCO2hy = 8.4 l min-1/%; VE/FetCO2ho = 12.7 l min-1/%) and non-snorers (VE/FetCO2hy = 7.6 l min-1/%; VE/FetCOho = 9.6 l min-1/%). Multiple regression analysis reveals that neck circumference, apnoea index, oxygen desaturation index, PCO2 and sex (male gender) are correlated with VE/FetCO2hy (R2 = 0.43). Multiple regression analysis also reveals that ERV (expiratory reserve volume) and sex (male gender) are correlated with VE/FetCO2ho (R2 = 0.21). Arguing against the hypothesis, patients with OSA displayed an increased hyperoxic and hypoxic ventilatory response to CO2. Nocturnal apnoea frequency and the obesity factor in OSA may have contributed to these results.

Adult↗
PubMed2000

Habitual snoring in an outpatient population in Japan.

In order to investigate the occurrence and history of sleep problems in Japan, the 11-Centre Collaborative Study on Sleep Problems (COSP) project was carried out. Complaints of snoring are examined, and its prevalence, risk factors and screening reliability are discussed. The subjects who participated in the study were 6445 new outpatients from a general hospital. They were asked to answer a sleep questionnaire that consisted of 34 items with seven demographic items; each item was composed of four grades of frequency. In order to offset possible seasonal variations in sleep habits, data were collected across four seasons. Sleep patterns, insomnia, hypersomnia, parasomnia and circadian rhythm sleep disorders were covered. Habitual snoring was seen in 16.0% of males and 6.5% of females. Male predominance was noted. From these data, the relationship between habitual snoring and sleep complaints was statistically analyzed. Habitual snorers (HS) were observed to wake up more frequently during sleep (17.8% of males, 21.5% of females) than were non-habitual snorers (NHS; 6.6% of males, 9.7% of females). Mid-sleep awakening of HS was also more frequent than it was for NHS; however, there were no differences in difficulty in falling asleep and early morning awakening. Body mass index, cigarette smoking and alcohol consumption were also correlated with habitual snoring.

Adult↗
PubMed2002

Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong.

OBJECTIVES: To assess the prevalence of sleep-disordered breathing (SDB) and its associated symptoms in a group of commercial bus drivers in Hong Kong. METHODS: Two hundred and sixteen of 410 bus drivers from three different shifts were interviewed with the Sleep & Health Questionnaire (SHQ) and the Epworth sleepiness scale (ESS) at a Hong Kong bus depot. Seventeen subjects from each shift were then randomly selected for at-home sleep study using the Mesam IV device (Madaus Medizin-Elektronik, Freiburg, Germany). RESULTS: There were 207 men and nine women (mean age 42.4 +/- 7.5 years; body mass index (BMI) 25.4 +/- 4.5 kg/m2; ESS 5.3 +/- 4.2). From the SHQ it was discovered that: (i) daytime sleepiness was reported by 87 subjects (40%), (ii) snoring > or = 3 times per week was reported by 80 subjects (37%), (iii) witnessed apnoea was reported by 17 subjects (7.9%) and (iv) 29 subjects (13.4%) reported having fallen asleep during driving. Among the 51 subjects who underwent the at-home sleep study: (i) 31 subjects (61%) had respiratory disturbance index (RDI) > or = 5 per hour of sleep, (ii) 21 subjects (41%) had RDI > or = 10 per hour of sleep, (iii) 12 subjects (24%) had RDI > or = 15 per hour of sleep and (iv) 35 subjects (68.6%) snored objectively > or = 10% of the night. Ten subjects (20%) had RDI > or = 5 and sleepiness at work, while five subjects (9.8%) had RDI > or = 5 and ESS > 10. No significant differences were noted in the SHQ responses, ESS, objective snoring or RDI among the three groups. Multiple regression analysis showed that BMI and witnessed apnoea were the only positive independent predictors of RDI. CONCLUSIONS: This study showed a high prevalence of objective snoring and SDB in a group of commercial bus drivers. Neither self-reported sleepiness nor the ESS could identify subjects with SDB.

Adult↗
PubMed2002

[Skin prick test results in snoring and sleep apnea patients].

BACKGROUND: In allergic rhinitis, nasal obstruction is a typical symptom. Reduced nasal ventilation is thought to be one causal factor for sleep breathing disorders. Whether or not snoring individuals with or without sleep apnea show more frequent or stronger reactions in skin prick tests (SPT) compared to non-snorers has not been investigated yet. METHOD: SPT on 20 most frequent allergens and standardized questionnaires of 412 patients of either sex who received a polysomnography at the sleeplab of the ENT department, University of Würzburg, Germany, were analysed retrospectively. In 351 patients (85 %), data were complete. According to their polysomnography, patients were grouped into snorers (n = 248, 71 %) and non-snorers (n = 103, 29 %) or apnea (apnea-hypopnea-index > 10; n = 171, 49 %) and non-apnea patients (n = 180, 51 %). Average occurrence or strength of skin reactions was compared between these groups. RESULTS: Except plantain (7 % vs. 1 %) and beech (10 % vs. 3 %), there were no statistical increases in the average occurrence or strength of SPT results in snoring individuals. Apnea patients did not show more frequent or stronger allergic skin reactions than non-apnea patients. Three patients suffering from allergic rhinitis by house dust mites were treated with citerizin 10 mg and allergen exposition prophylaxis. Three months after onset of therapy in all three patients, a reduction of snoring was polysomnographically observed. Snorers or apnea patients complaining sneezing, reduced nasal ventilation at night, hyperlacrimation or rhinorrhea showed significant higher numbers of allergic skin reactions for rye, gras and house dust mites compared to patients without these symptoms. CONCLUSIONS: The results reveal that only snorers or apnea patients with specific symptoms for allergic rhinitis should be tested by SPT. A general SPT-screening seems not to be indicated. Snoring and apneas in patients with allergic rhinitis due to house dust mites can be eliminated or reduced by an oral antihistaminic treatment.

Adolescent↗
PubMed1989

[What is new in nasopharyngeal video fiber optic endoscopy in the diagnosis of snoring and patients with obstructive apnea?].

Videoendoscopy of the oropharynx was performed in 57 patients with habitual snoring and obstructive sleep apnoea syndrome. Endoscopy was done in waking supine subjects relaxed and during voluntary snoring, Esmarch's and modified Müller's manoeuvre. Evaluation of results for the first time was semiquantitative. Statistical analysis showed significant correlations (p less than 0.004) between movements of the base of the tongue and the modified Müller's manoeuvre. For the first time it could be shown that the dynamic changes in the pharyngeal walls during voluntary snoring are identical with those in the modified Müller's manoeuvre (p less than 0.006). Frame-by-frame analysis demonstrated epiglottic movements in the inspiratory cycle of snoring which result in a massive occlusion of the airway in 65% of our patients. Videoendoscopy is able to provide valuable information on anatomical details and potential obstructive sites but cannot predict the success of surgical interventions like UPPP. Videoendoscopy due to its high resolution in the time domain can demonstrate pathophysiological events which are otherwise inaccessible. For the experienced examiner videoendoscopy is a fast tool for obtaining live information on the surgical site.

Airway Obstruction↗
PubMed1999

Failures in snoring and OSAS surgery.

Significant reduction of snoring noise and valid prevention of neurological and/or cardiovascular complications of OSAS are the basic goals of all modern snoring and OSAS surgical procedures. Any kind of operation, single or multiple, included into a one-step or multistep programs, is said to fail if snoring is not reduced to a significant extent for the patient or if clinical and/or instrumental data after the operation show that Upper Airways Resistance Syndrome (UARS) or OSAS continues to be probably dangerous for the patient to some extent. The real figure of failures in different situations of sleep-disordered syndromes surgery is discussed, along with the possible explanations. A group of patients operated on for snoring and OSAS in our clinic is analyzed retrospectively from the subjective point of view and by means of sleep studies to get a precise quantitative and qualitative idea of the failed cases. The final goal would be to understand how it is possible to reduce to a minimal level the number of true failures.

Adult↗
PubMed2004

Pilot study of a novel mandibular advancement device for the control of snoring.

OBJECTIVE: Mandibular advancement devices (MADs) have been introduced as a conservative, non-invasive treatment for socially disturbing snoring and mild obstructive sleep apnea (OSA). A prospective, non-randomized pilot study was conducted to investigate the efficacy, feasibility, side-effects and compliance of Somnoguard, an immediately intraorally adaptable MAD made from thermoplastic material. MATERIAL AND METHODS: Twenty consecutive heavy snorers with a respiratory disturbance index of <20 events/h were prospectively selected. Prior to the adaptation of the appliance, ambulatory polygraphy was carried out without a MAD. After a 1-month habituation period, a polygraphic evaluation was carried out with the device. Treatment success was defined as a reduction in the apnea-hypopnea index (AHI) of at least 50%. RESULTS: The results indicated a success rate of 65%. The AHI decreased from 8.4 +/- 2.9 events/h at baseline to 3.9 +/- 1.8 events/h with the device (p = 0.001). At 1-month follow-up, significant reductions in the snoring index (p < 0.001) and the Epworth Sleepiness Scale (ESS) score (p = 0.036) were noted. At 6-month follow-up, similar results were achieved, with significant drops in the snoring index (p = 0.025) and ESS score (p = 0.033). CONCLUSION: We conclude that immediate intraoral adaptation of a low-cost fabricated "one-size-only" MAD is a feasible and well-tolerated treatment for snoring and mild OSA. Further research is needed to evaluate this thermoplastic appliance as a strategy to "screen" the efficacy of MAD treatment in the individual patient with a less expensive appliance before constructing a more expensive custom-made MAD.

Adult↗
PubMed2006

An update on childhood snoring.

UNLABELLED: Habitual snoring or daily snoring is a symptom of sleep-disordered breathing (SDB) in children and it is reported in about 10% of children. SDB includes primary snoring, upper airway resistance syndrome (UARS), obstructive hypoventilation syndrome and obstructive sleep apnea syndrome (OSAS). Classification of SDB in a particular snoring child requires an overnight polysomnography (PSG). Manual scoring of PSG is mandatory in children. Risk factors for SDB include allergic rhinitis, passive smoking, obesity, dysmorphic syndromes and neuromuscular disorders. CONCLUSION: Treatment includes general measures like treatment of allergic rhinitis, weight reduction in obese children, and avoidance of sleep deprivation. Specific measures include removal of adenoid and tonsils. Complications of SDB include neurocognitive impairment, hypertension and failure to thrive.

Cardiovascular Diseases↗
PubMed1987

Snoring and dementia.

The frequency of snoring was studied in 46 patients with Alzheimer's disease (AD), 37 with multiinfarct dementia (MID), and in a random sample of 124 elderly community residents without known diseases affecting higher cortical functions. The demented patients were reported to snore twice as frequently as the control subjects (P less than 0.05). No difference in the frequency of snoring was present between the patients with AD and MID. In contrast to younger populations, snoring was not significantly associated with cardiovascular morbidity in this elderly population.

Adult↗
PubMed1993

Snoring, sleep apnoea and cardiovascular risk factors: the MONICA II Study.

The objective of this study was to evaluate the cardiovascular risk profile in self-reported snorers and sleep apnoeics in an adult representatively-selected population. A total of 1504 males and females, aged 30, 40, 50 and 60 years were included. The following were measured: snoring, alcohol and tobacco consumption by questionnaire, blood pressure, serum high density lipoprotein (HDL) and total cholesterol. Nocturnal respiration was determined in 748 participants. Respiratory distress index (RDI) was defined as the number of apnoea and hypopnoea lasting longer than 10 seconds per hour sleep. Habitual snoring was reported by 19.1% (9.2-24.2%, aged 30-60 years) of males and 7.9% (3.8-11.7%, age 30-60 years) of females. An RDI > or = 5 was found in 10.9% (7.1-18.3%, age 30-60 years) of males and in 6.3% (5.3-7.6%, age 30-60 years) of females. The following factors were associated with snoring: age (P < 0.02), sex (P < 0.001), body mass index (BMI) (P < 0.0001), alcohol (P < 0.05) and tobacco (P < 0.01) consumption. An RDI > or = 5 was associated with sex (P < 0.001), age (P < 0.05), BMI (P < 0.0001), tobacco (P < 0.02) and alcohol (P < 0.05) consumption. Self-reported snores showed higher systolic (P < 0.001) and diastolic (P < 0.001) blood pressure and total cholesterol (P < 0.001) and a lower HDL (P < 0.001). The participants with RDI > or = 5 showed higher systolic and diastolic blood pressure (P < 0.001) and total cholesterol (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Are snoring medical students at risk of failing their exams?

STUDY OBJECTIVES: To compare the examination results of self-reported snoring and nonsnoring medical students DESIGN: We studied the examination scores obtained by medical students answering a multiple-choice test forming part of their final examinations. The students were asked to classify themselves as "nonsnorers," "occasional snorers," or "frequent snorers," and to state their age, sex, height and weight. SETTING: University Hospital, Erlangen, Germany PARTICIPANTS: 201 medical students (61% males/39% females; mean age 24.6 +/- 2.1 years; BMI 22.4 +/- 2.5 kg/m2) taking their final examinations in internal medicine. MEASUREMENTS AND RESULTS: Seventy-eight students (38.8%) claimed to be nonsnorers, 99 (49.3%) occasional snorers and 24 (11.9%) frequent snorers. The mean examination scores (adjusted for age, sex, and BMI) were 69.6 +/- 9.9% for the nonsnorers, 65.3 +/- 10.0% for the occasional snorers and 62.0 +/- 8.2% for the frequent snorers (p < 0.0001). 12.8% of the nonsnorers failed the exam, compared with 22.2% of the occasional snorers and 41.7% of the frequent snorers (p < 0.001). Logistic regression analysis showed an association between failing the exam and snoring (p = 0.013), but not between failure and age, BMI, or sex (relative risk for snorers adjusted for age, sex and BMI: 1.26; 95%--CI 1.01-1.57). CONCLUSIONS: In medical students, snoring seems to be associated with an increased risk of failing exams in a dose-response manner, even after controlling for age, sex and BMI. For the present, the mechanisms underlying this association must remain a matter of speculation. Snoring-related sleep fragmentation ("upper airway resistance syndrome") might be a causal factor.

Achievement↗
PubMed1999

Dental side effects of an oral device to treat snoring and obstructive sleep apnea.

STUDY OBJECTIVES: Snoring and obstructive sleep apnea (OSA) are common and related conditions--with major social and health implications--which can be treated successfully with dental devices that reposition the mandible. Despite wide use, side effects of these devices have not yet been systematically evaluated. The purpose of the study was to evaluate side effects of a mandibular advancement splint (MAS) previously described by the authors. DESIGN: Questionnaire survey and dental examination of a consecutive case series of patients treated with the MAS SETTING: Dental outpatient clinic PATIENTS: Attempts were made to contact all 191 patients treated over a 5-year period. All had snored loudly and habitually with or without OSA prior to treatment. MEASUREMENTS AND RESULTS: Of 191 patients treated, 132 agreed to complete the questionnaire. All were scheduled to attend for dental examination and 106 underwent examination. Of the 132 interviewed, patient and partner report indicated that the device was well tolerated and controlled snoring satisfactorily in 100 after 31 +/- 18 (mean +/- SD) months of use. Dental side effects were reported in 107 patients, although these were mostly minor, and only 10 patients ceased using the device because of them. Side effects included excess salivation (in 40), xerostomia (in 30), temporomandibular joint pain (in 35), dental discomfort (in 35), myofacial discomfort (in 33) and bite changes (in 16). Of 106 patients examined, 30 had increased maximal opening and 76 had no change compared with pretreatment records. Temporomandibular joint noises were found in 9 patients, and occlusal changes (12 m mylar strip and wax bite, relative to pretreatment) in 15. None of these effects could be related to degree of opening or protrusion produced by the MAS. CONCLUSION: Dental side effects occur in a significant proportion of patients using the MAS. In most cases these are minor and their importance must be balanced against the efficacy of the MAS in treating snoring and OSA.

Adult↗
PubMed2005

Vibration enhances interleukin-8 release in a cell model of snoring-induced airway inflammation.

STUDY OBJECTIVES: To test a cell model of snoring-induced airway inflammation and to assess whether a vibration stimulus simulating the one experienced by airway tissues in snoring patients induces inflammation in airway epithelial cells. DESIGN: Prospective controlled study in cell culture. SETTING: University laboratory. PATIENTS OR PARTICIPANTS: Human bronchial epithelial cells (BEAS-2B cell line). INTERVENTIONS: Cell cultures were subjected to vibration (60 Hz, +/- 0.3 mm) for time periods of 6 hours, 12 hours, and 24 hours. The vibratory stimulus was applied with and without treatment with inhibitors of the 3 main pathways of mitogen-activated protein kinases (MAPK): p38, MEK1/2, and JNK. MEASUREMENTS AND RESULTS: The effect of vibration was assessed by comparing cell proliferation and release of interleukin-8 (IL-8; measured by enzyme-linked immunosorbent assay) in cells subjected to the vibratory stimulus (both when treated and untreated with MAPK inhibitors) and in controls. Application of vibration up to 24 hours did not significantly modify cell proliferation. By contrast, the concentration of IL-8 in the supernatant was significantly increased after 12 hours and 24 hours of vibration. The inhibition of the p38, MEK1/2, and JNK MAPK pathways significantly reduced the overexpression of IL-8 resulting from the vibration stimulus. CONCLUSIONS: A mechanical vibration simulating snoring triggered an inflammatory cascade, as reflected by the increase in IL-8 release mediated by MAPK pathways. The novel model developed is potentially applicable to studying the effects of the vibration due to snoring in the different cell types (epithelial, endothelial, muscular, neuronal) involved in airway pathophysiology during respiratory sleep disturbances.

Biomarkers↗